Overview
Meningitis is inflammation of the thin protective layers (the meninges) around the brain and spinal cord. It is usually caused by a virus or bacteria, and sometimes by the TB germ, fungi or other causes.
Viral meningitis is more common and usually milder. Bacterial meningitis is rarer but can be life-threatening, and only tests can tell the two apart.
Symptoms
Symptoms often start suddenly and can look like flu at first. Not everyone has all of them. In older children and adults they can include:
- Fever, sometimes with cold hands and feet
- A severe headache that gets worse
- A stiff neck
- Dislike of bright light
- Vomiting
- Confusion
- Unusual sleepiness or difficulty waking
- A fit (seizure)
- A rash that does not fade under a pressed glass
Babies may refuse feeds, cry in an unusual or high-pitched way, be floppy or stiff, or have a bulging soft spot on the head. For the glass test, press the side of a clear glass firmly on the rash. Spots that stay visible through the glass do not fade. On brown or black skin, look at the palms, soles and inside the eyelids.
When to see a doctor
Trust your instincts: if someone seems seriously unwell, get help even without every symptom. If you are the one who is ill, do not drive yourself.
Causes
Many viruses and bacteria can cause meningitis. The most common bacterial causes are pneumococcus and meningococcus, along with Hib and, in newborns, group B streptococcus. Many of these germs live harmlessly in the nose and throat. They spread through close contact, such as kissing, sharing drinks or living in the same home, often from people who are not ill themselves.
Risk factors
- Being a baby or young child, a teenager or young adult, or an older person
- A weakened immune system, for example from HIV or
- Close contact with a person who has the infection
- Missing vaccines against the bacteria that cause it
Complications
Viral meningitis usually causes no long-term problems. Bacterial meningitis can be fatal and may leave lasting effects, including:
- Hearing loss or vision problems
- Seizures
- Problems with movement and coordination
- Difficulty with memory and concentration
- Stroke or brain damage
- Blood poisoning (sepsis), which can damage the limbs
Prevention
- Keep vaccines up to date. Vaccines exist against Hib, pneumococcus and meningococcus, though no single covers every cause
- Wash hands often
- Avoid sharing drinks, utensils and toothbrushes
- If someone close to you has bacterial meningitis, ask a doctor about preventive
Diagnosis
Hospital tests are needed to find the cause. They may include blood tests, a scan of the brain, and a lumbar puncture (spinal tap), in which a small sample of the fluid around the spinal cord is tested. If bacterial meningitis is suspected, doctors start without waiting for the results.
Treatment
Bacterial meningitis is treated in hospital, usually for at least a week. Care may include and fluids through a drip, oxygen through a face mask, and a steroid medicine to reduce swelling and the risk of brain damage.
Viral meningitis usually improves within 7 to 10 days and can often be managed with rest, painkillers and anti-sickness medicine once a doctor has confirmed the cause. Other types, such as tuberculous meningitis, need different medicines chosen by the doctor.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Meningitis always comes with a rash, so no rash means it is not meningitis.”What is true?
Fact
Not everyone with meningitis gets a rash. A rash that does not fade under a pressed glass is a warning sign, but waiting for it can cost precious time. A fever with a severe headache, stiff neck, confusion or sleepiness needs urgent care with or without a rash.
Myth“Meningitis only affects children.”What is true?
Fact
Anyone can get it. It is more common in babies and young children, teenagers and young adults, older people, and people with a weakened immune system, such as those living with HIV.
Myth“It is just a bad viral fever that will go away by itself.”What is true?
Fact
Viral meningitis is more common and usually gets better on its own, but bacterial meningitis is rarer and far more dangerous. It needs antibiotics in hospital and can be fatal. Only tests can tell them apart, so every suspected case needs hospital care.
Myth“Meningitis cannot spread from one person to another.”What is true?
Fact
Many of the germs that cause it spread through close contact, such as kissing, sharing drinks or living in the same home, often from people who carry the germ but are not ill. Close contacts of a person with bacterial meningitis should ask a doctor about preventive antibiotics.
Myth“Wait a day at home to see whether the fever and headache settle.”What is true?
Fact
Meningitis can get serious very quickly, and early symptoms can feel like flu or a stomach bug. If a fever comes with a severe headache, stiff neck, vomiting, confusion or sleepiness, get care straight away. Early treatment can prevent serious problems, including death.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
How is bacterial meningitis different from viral meningitis?
Viral meningitis is more common and usually gets better on its own within 7 to 10 days. Bacterial meningitis is rarer but far more serious and needs antibiotics in hospital. They can look alike at first, so anyone with suspected meningitis should be seen in hospital.
Is meningitis contagious?
Many of the germs that cause it spread through close contact, such as kissing, sharing drinks or living together, often from people who carry the germ without being ill. Close contacts of someone with bacterial meningitis should ask a doctor whether they need preventive antibiotics.
Can vaccines prevent meningitis?
Vaccines protect against some of the bacteria that cause it, including Hib, pneumococcus and meningococcus. No single vaccine covers every cause, so a vaccinated person should still get help quickly if symptoms appear. Ask your doctor which vaccines suit you or your child.
Will a person recover completely?
Most people with viral meningitis recover fully. Bacterial meningitis can be fatal and may leave lasting effects, such as hearing loss, fits or problems with memory and movement. Early treatment gives the best chance of avoiding these.
